Uveal Melanoma: Symptoms, Diagnosis and Treatment

Uveal melanoma is a rare cancer arising from pigment-producing cells in the uvea, the middle layer of the eye. It may affect the iris, ciliary body or choroid. Diagnosis and treatment require an ophthalmic-oncology team; symptoms and photographs alone cannot confirm or exclude it.

Key Points

Most pigmented marks inside the eye are not melanoma, but suspicious lesions need specialist assessment and documented follow-up.
Uveal melanoma differs biologically from melanoma of the skin and should not be assigned the same prevention claims or staging rules.
Treatment depends on tumour location, size, visual potential, spread risk and the person’s health and priorities.
Controlling the tumour in the eye does not remove the need for systemic surveillance.
New visual symptoms need eye assessment; sudden sight loss is urgent even when cancer is not the likely cause.

Where Uveal Melanoma Develops

The uvea includes the iris at the front of the eye, the ciliary body behind it and the choroid beneath the retina. Melanoma can arise in any of these tissues. Choroidal and ciliary-body tumours may remain hidden from view, while some iris lesions are visible as a changing coloured area.

Location affects symptoms, examination, treatment choices and prognosis. A pigmented lesion is not automatically malignant; specialists compare its clinical and imaging features and, when appropriate, change over time.

Symptoms and Urgent Changes

Possible symptoms include blurred or distorted vision, flashes, new floaters, a shadow in the visual field, a visible iris change, altered pupil shape or pain. Many uveal melanomas cause no symptoms and are found during an eye examination. These features also have more common non-cancerous causes.

Seek urgent eye care for sudden loss of vision, a new curtain or shadow, flashes with a sudden increase in floaters, severe eye pain or acute neurological symptoms. Do not wait for travel or an online consultation.

Risk Factors and Uncertainty

Recognised associations include older age, lighter eye colour, certain atypical moles or ocular pigmentation conditions and rare inherited BAP1 tumour-predisposition syndrome. Having a risk factor does not mean that cancer will develop, and people without known risk factors can still be diagnosed.

The relationship between ultraviolet exposure and uveal melanoma is not established in the same way as for cutaneous melanoma. Sun protection remains sensible for skin and general eye health, but it should not be presented as proven prevention of uveal melanoma. Genetic testing is considered from personal and family history with specialist counselling, not from a generic checklist.

Specialist Eye Examination

Assessment may include visual acuity, slit-lamp examination, dilated examination of the retina, fundus photography, ocular ultrasound and optical coherence tomography. Gonioscopy, autofluorescence or angiography may be useful in selected cases.

Many intraocular tumours are diagnosed from their appearance and imaging. Biopsy is not required for every lesion and carries eye-specific risks. It may be considered when the diagnosis is uncertain or when tumour genetics will inform prognosis or treatment. The specialist team should explain the purpose and limits.

Staging and Systemic Assessment

Staging considers tumour size and location, involvement of nearby eye structures and evidence of spread outside the eye. Uveal melanoma has a particular tendency to spread through the bloodstream, with the liver an important surveillance site.

Blood tests and imaging are selected by the oncology team. A normal scan cannot guarantee that future metastasis will not occur. Surveillance intervals and modality should reflect specialist guidance, tumour features, treatment and the patient’s circumstances.

Eye-Preserving Treatment

Radiotherapy is commonly used to control suitable tumours while retaining the eye. Options can include plaque brachytherapy or external-beam techniques such as proton-beam therapy, depending on tumour characteristics and service availability. Local resection or laser-based approaches have narrower, specialist indications.

Preserving the eye does not guarantee preservation of useful vision. Radiation can affect the retina, optic nerve, lens and other structures, sometimes months or years later. Cataract, glaucoma, retinal damage, visual-field loss, pain and further procedures may occur.

Enucleation and Reconstructive Care

Removal of the eye may be recommended for a large tumour, a painful or severely damaged eye, or when eye-preserving treatment is unsuitable. The decision is based on cancer control, comfort, expected vision and individual circumstances rather than a single size rule copied from the internet.

The team should discuss the implant and prosthetic-eye pathway, appearance, depth perception, driving considerations, emotional support and follow-up. A prosthesis can improve appearance but does not restore sight.

Metastatic Disease and Systemic Treatment

If disease has spread, management should involve a specialist oncology multidisciplinary team. Treatment may include systemic therapy, liver-directed treatment, surgery or a clinical trial depending on tumour biology, sites of disease, fitness and availability.

Tebentafusp is an option for some patients with a specific HLA type and unresectable or metastatic uveal melanoma; it is not suitable for everyone. Other immunotherapies used for skin melanoma do not necessarily have the same effect in uveal melanoma. Eligibility and expected benefit require oncology review.

Understanding Prognosis

Prognosis varies with tumour size and location, chromosome and gene-expression features, spread at diagnosis, treatment response and general health. Population statistics combine different patients and time periods and cannot predict one person’s outcome.

Ask the specialist which evidence applies to the individual tumour, what uncertainty remains and how results would change surveillance or treatment. Broad eye-cancer survival figures should not be presented as uveal-melanoma predictions.

Follow-up After Local Treatment

Follow-up can monitor tumour control, vision, eye pressure, radiation effects and systemic health. New visual symptoms, pain, jaundice, unexplained weight loss or persistent general symptoms should be discussed with the relevant clinical team, while recognising that these symptoms have many possible causes.

International care requires written pathology and imaging records, a named oncology contact, an emergency route and a clear division of responsibility between destination and local teams.

Planning Care Through Revitalize

Revitalize should only coordinate uveal-melanoma care with a named ophthalmic-oncology specialist and contracted facility. Confirm professional registration, multidisciplinary review, diagnostic evidence, treatment purpose, alternatives, visual consequences and arrangements for long-term systemic surveillance.

For help organising records and a specialist review, contact Revitalize support. Suspected cancer or acute visual loss should follow an urgent local pathway rather than wait for travel.

Independent Patient Information

Frequently Asked Questions

Is every eye freckle a melanoma?

No. Many are benign, but suspicious or changing lesions need specialist assessment and monitoring.

Can treatment guarantee that cancer will not spread?

No. Local control and metastatic risk are related but different issues, so systemic surveillance may still be advised.

Does retaining the eye guarantee useful vision?

No. The tumour and treatment can both affect vision, sometimes after a delay.

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